Diagnosis Symptoms

Nasal cavity and paranasal sinus malignancies often do not cause symptoms until they have expanded to a significant size or have extended through the bony confines of the sinus cavity. These tumors therefore tend to present at a more advanced stage. Symptoms may initially include nasal obstruction, epistaxis, pain, and episodes of sinusitis. Tumor expansion inferiorly towards the oral cavity may be associated with swelling of the gingiva or palate with loose teeth, while orbital invasion may lead to ocular symptoms such as proptosis, diplopia, decreased acuity, and restriction of ocular motion. Extension laterally into the pterygoid musculature may cause trismus and deeper invasion into the infratemporal fossa. Anterior extension through the anterior maxillary wall may cause visible cheek swelling and numbness from involvement of the infraorbital nerve. In rare cases, posterior and superior extension into the skull base, dura and brain may lead to headache, cerebrospinal fluid leak, and central nervous system deficits.

Mass Hard Palate
Figure 11-2. A hard palate and gingival bulge results from the inferior extension of a left maxillary sinus mass into the oral cavity.

general neurologic evaluation. A thorough intranasal exam is essential, using a flexible or rigid endoscope for optimal visualization of the nasal cavity and nasopharynx. Although gross tumor may be obvious, subtle irregularities in the nasal mucosal lining or fullness in the lateral or superior nasal cavity wall should also be carefully assessed. A thorough neck examination should be performed to evaluate for palpable lymph node metastases.

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